Blind liver biopsy is sufficient for patients with diffuse-parenchymatous liver diseases. The accuracy rate of guided, laparoscopic liver biopsy is not enhanced.

Endoscopic ultrasonography makes it possible to measure and examine the wall of the upper gastrointestinal tract. It complements endoscopic visualization of the surface with analysis of the wall layers. Endoscopic ultrasound imaging reveals five different layers. Preliminary results indicate that benign gastric tumours can be distinguished from infiltrating gastric carcinoma. The extent and adjoining reaction of a gastric ulcer can also be visualized. Endoscopic ultrasonography of the stomach is a method of investigation that can be further developed and already shows considerable diagnostic potential.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Endoscopic ultrasonotomography opens a sonographic window to the organs of the mediastinum. With this technique all segments of the oesophagus can be sonographically investigated. Endosonographic investigations on 11 patients with oesophageal tumors and 3 patients with oesophageal varices showed that the diagnosis of oesophageal carcinoma and differentiation between malignant tumors and benign changes are possible. The spread of the tumor in the horizontal and vertical planes can be accurately determined with endoscopic ultrasonography. In addition, paraoesophageal lymph node metastases, as well as other lesions in the mediastinum, can be diagnosed. Ultrasonography of the oesophagus can be simplified by leaving out the optical system.

Glucocorticosteroids (GCS) are established in the treatment of active Crohn's ileitis and ileocolitis. Recently, the topical steroid budesonide was found to be effective in untreated patients with Crohn's disease (CD) causing less side effects than conventional GCS. No clinical data have been reported about the effects of switching from conventional GCS to budesonide in terms of side effects and disease activity. The primary aim of this study was to evaluate the development of side effects after switching from conventional GCS treatment to Eudragit L-coated budesonide (pH-modified release formulation) in patients taking 5–30 mg prednisolone equivalent per day for at least two weeks. In all, 178 patients with active CD (N = 88) or CD in remission during GCS treatment (N = 90) were included. Conventional GCS treatment was tapered down during a maximum of three weeks, with simultaneous intake of 3 × 3 mg budesonide. Thereafter, patients received 3 × 3 mg budesonide alone for six weeks. GCS-related side effects, disease activity and adverse events were documented at study entry and after 0, 2, 4, and 6 weeks of budesonide treatment. The percentage of patients with GCS-related side effects decreased from 65.2% (intention-to-treat-population) at entry to 43.3% (P < 0.0001) at the end of the trial. The total number of GCS-related side effects decreased significantly from 269 to 90. Of the patients who entered the study with active disease under conventional GCS therapy, 38.6% were in remission at the end of the study. Of the patients who entered the study with CD in remission, 78% stayed in remission after switching from conventinal GCS to budesonide. In conclusion, switching from conventional GCS treatment to budesonide leads to a significant reduction of GCS related side effects in patients with CD without causing rapid deterioration of the disease.

Die Alternative zur Operation von Pankreaspseudozysten (PPZ) besteht in der ultraschallgezielten Punktion oder in der perkutanen Drainage. Der Effekt einer einmaligen Punktion von PPZ ist jedoch gering, da sich PPZ in der Regel innerhalb von Stunden oder von wenigen Tagen wieder auffüllen. In der folgenden Untersuchung wurde daher geprüft, ob es gelingt, PPZ zur Rückbildung zu bringen, wenn man die Punktion nur oft genug wiederholt; das heißt, ob die Serienpunktion als alternative Behandlungsform empfohlen werden kann.

Endoscopic ultrasonography (EUS) enables an exact evaluation of the wall of the upper GI tract. The esophageal and the gastric wall give a typical five-layer image, presumably corresponding to the mucosa, submucosa, tunica muscularis propria, and serosa. Gastric ulcers are often accompanied by a thickening of the gastric wall (10.4 ± 3.7 mm) compared with the normal gastric wall (3.7 2 0.6 mm; p < 0.001). Malignant tumors show an irregular structure with infiltration into the wall and into neighboring tissues with destruction of the GI wall. Para-esophageal and para-gastric lymph node metastases can be visualized. Benign esophageal and gastric tumors are sharply delineated from the surrounding tissue. The results suggest that, by EUS, it is possible to differentiate carcinomas from benign submucosal tumors of the upper GI tract and to judge the extent of the infiltration and the stage of the malignant process.

For 15 years it has been possible to dissolve cholesterol gallstones with chenodeoxycholic acid or ursodeoxycholic acid. There are now about 30 different chenodeoxycholic and ursodeoxycholic acid preparations available worldwide [10].

Fourteen male patients with coronary heart disease were randomly assigned to treatment periods with isosorbide dinitrate (ISDN) 120 mg/day (6 X 20 mg) and placebo for 4 weeks each, according to a double-blind protocol with intraindividual cross-over. The luminal diameters of the superior mesenteric artery, the hepatic artery, the superior mesenteric vein and the portal vein were determined sonographically in the supine position on days 1, 14 and 28 of both treatment periods 90 min after drug intake. The measurements were repeated after 1.6 mg sublingual nitroglycerin. On day 1 of drug intake the vessel diameters increased significantly after ISDN as compared to placebo: superior mesenteric artery: +11%; hepatic artery: +26%; superior mesenteric vein: +17%; portal vein: +11% (p less than 0.05). No differences in luminal diameters between both drug regimens were found on days 14 and 28. Additional nitroglycerin caused a marked diameter increase during the placebo period (14-21%; p less than 0.001) and on days 14 and 28 of ISDN therapy, while the drug effects were absent after maximal ISDN-induced vasodilatation on day 1. Thus, nitroglycerin and isosorbide dinitrate administered acutely caused a comparable vasodilatation of arterial and venous vessels in the splanchnic region. During sustained therapy with isosorbide dinitrate the vasodilatory effects of the drug were lost. It is supposed that a decrease of blood pooling in the splanchnic region occurs during sustained ISDN therapy. Despite this tolerance development to the circulatory effects of isosorbide dinitrate, nitroglycerin remained effective with regard to arterial and venous vasodilatation.

Bile acids are supposed to promote colonic cancer. In Crohn's disease, colonic carcinomas are relatively rare. We, therefore, compared ileal and right colonic mucosal bile acids analysed by gas-liquid chromatography in 8 patients with ileal Crohn's disease (14-48 yrs.) and 7 patients with right colonic carcinoma (28-77 yrs.) who underwent surgery. In both ileal and colonic mucosa, nonsulphated bile acid concentrations were somewhat higher in Crohn's disease (20.98 micrograms/g +/- 4.77 SEM; 12.09 micrograms/g +/- 2.55) than in colonic carcinoma (16.06 micrograms/g +/- 3.46; 7.75 micrograms/g +/- 4.28). In ileal mucosa, percentages of lithocholic and deoxycholic acids were slightly higher in colonic carcinoma (3.9%; 23.2%) than in Crohn's disease (1.1%; 14.9%). In colonic mucosa, carcinoma patients had more lithocholic (7.6%) and less deoxycholic acid (11.9%) than patients with Crohn's disease (1.7%; 20.3%). Bile acid sulphate esters were similar in both diseases (ca. 3.0 micrograms/g in ileal, 1.4 micrograms/g in colonic mucosa). Our results show that ileal and right colonic mucosal nonsulphated bile acids tend to be even lower in right colonic carcinoma than in Crohn's disease. This agrees well with our earlier findings of low mucosal bile acid concentrations in patients with left colonic carcinoma (Tokai J Exp Clin Med 8: 59-69, 1983) and does not support the assumption that bile acids are envolved in right colonic carcinogenesis.

Endoscopic ultrasonotomography opens a sonographic window to the organs of the mediastinum. With this technique all segments of the oesophagus can be sonographically investigated. Endosonographic investigations on 11 patients with oesophageal tumors and 3 patients with oesophageal varices showed that the diagnosis of oesophageal carcinoma and differentiation between malignant tumors and benign changes are possible. The spread of the tumor in the horizontal and vertical planes can be accurately determined with endoscopic ultrasonography. In addition, paraoesophageal lymph node metastases, as well as other lesions in the mediastinum, can be diagnosed. Ultrasonography of the oesophagus can be simplified by leaving out the optical system.

Die konventionelle Ultraschalltomographie wird durch sog. Ultraschall-barrieren wie Knochen und Luft z. T. erheblich limitiert. Auch dem Auflösungsvermögen, das von der Frequenz des Ultraschalls abhängt, sind physikalische Grenzen gesetzt. Denn mit zunehmender Frequenz nimmt die Eindringtiefe des Ultraschalls ab. Das endosonographische Prinzip, nämlich das Einbringen von Ultraschallsonden in den Körper, ist daher eine folgerichtige Entwicklung. Mit der Endosonographie lassen sich sonographisch Hindernisse umgehen. Andererseits ermöglicht die nahe Lage einer Ultraschallsonde am Zielorgan die Anwendung hoher Ultraschallfrequenzen, da auf eine große Reichweite der Ultraschallstrahlen verzichtet werden kann.

La tomographie endoscopique ð ultrasons (TEU) abolit les barrières classiques des ultrasons telles que les gaz et les os et procure un pouvoir de résolution supérieur grâce ð l’utilisation de hautes fréquences. Les données de l’anatomie sonographique sont complètement modifiées et elles nécessitent de plus une standardisation stricte des sections croisées et des positions. Le présent travail représente l’expérience de 110 patients examinés par TEU au niveau du tractus digestif supérieur et des organes environnants. Les maladies pancréatiques et les lésions des voies biliaires sont souvent mieux visualisées par TEU que par ultrasonographie conventionnelle. Les lésions tant bénignes que malignes de l’estomac et de l’œsophage sont décrites avec une précision jusqu’ici inconnue et la TEU est appelée ð devenir une méthode d’investigation d’importance primordiale au niveau des lésions du tractus digestif supérieur.

The reasons for the sometimes poor imaging of different organs and structures are mainly to be explained by limiting factors in conventional ultrasound tomography (UT). It is the aim of endoscopic UT ( EUT ) to omit the limiting factors and to overcome the ultrasound barriers like ribs and gas. High frequencies enable a better discrimination of details. Preliminary indications of EUT will be: tumors of the pancreas, of the spleen kidney angle, of biliary ducts, of the stomach, of the liver and the gallbladder, choledocholithiasis, adrenal disorders, and cardiac diseases.

786 consecutive patients with suspected gallstones investigated radiologically and ultrasonographically, 231 (33.0%) were found to have stones. Radiological examinations showed that 59.3% of these were suitable for chemical dissolution with cheno- or ursodeoxycholic acid. The percentage of treatable patients fell from age 20 to age 65 from 71% to 48% (p less than 0.05) and then rose again to 61% (not significant). The benefit of litholysis is greater, the earlier it is begun. The results are in disagreement with those of two studies in operated patients. Here only 19-24% were suitable for stone dissolution. Comparative ultrasonographic and radiological studies in 23 patients have shown that monitoring of patients during litholysis can be carried out ultrasonographically. Stone size measured ultrasonographically corresponds sufficiently accurately with that obtained radiographically.

Two-dimensional (transthoracic) echocardiography (2DE) and two-dimensional endoscopic (transoesophageal) echocardiography ( 2DEE ) were performed in 19 consecutive patients with atrial septum defect (ASD), and in 17 controls, 3 with ventricular septum defect (VSD) and 14 with various diseases. In detection of ASD the sensitivity was 61% (11/18) and the specificity 88% (2/17) with 2DE whereas 2DEE revealed a sensitivity of 95% (18/19) and a specificity of 100% (0/17). 2DEE enabled to visualize the VSD in all 3 patients (2DE in 1/3). With 2DEE the site and size of the atrial septum defects could be estimated well as confirmed in 14 patients who underwent cardiac surgery. The lateral resolution of the 7.5 MHz transoesophageal probe was about 0.5 cm. Further studies are required to clarify if cardiac catheterization prior to surgery of an ASD may be replaced by 2DEE .

Gastroscopic ultrasound tomography enables a direct sonographic approach to the upper gastrointestinal tract and the surrounding organs. First experiences show that this new method is characterised by a great diagnostic potential. Its advantages compared with conventional sonography are the avoidance of sonographic obstacles and an improved recognisability of details; part of the examined area is, so to say, enlarged due to the use of high ultrasonic frequencies. With an ultrasonic frequency of 7.5 megahertz, the following processes can be visualised more clearly than with conventional sonographic equipment: processes in the pancreas, cholelithiasis of the common bile duct, hepatic foci, processes in the splenorenal angle, as well as tumours of the stomach and of the esophagus. In cardiology, clear indications are easily recognised, such as the atrial septal defect.